ASM Microbe 2016 (Poster 290)
Community-onset CDI cases increased at a higher rate than hospital-acquired cases—accounting for almost half of the cases—in an examination of clinical data from 154 U.S. hospitals over eight years, according to research presented at the ASM Microbe 2016 (Poster 290)
Researchers from Merck and Becton Dickinson wanted to examine this trend, and looked at where CDI began by analyzing clinical data from 154 hospitals from 2008 to 2015.
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A CDI case was defined as a positive C. difficile toxin or molecular assay of a stool specimen obtained from a patient without a positive assay in the previous eight weeks.
First, they looked at the overall CDI rate in those facilities in that eight-year period and found 154,629 total CDI cases.
Then the teased out whether the case was acquired in the community or hospital. They also dived a little deeper to understand which community cases really were “community” that is there was no hospital stay within a certain time before the onset of disease, explained Andy DeRyke, PharmD, director scientific strategy lead at Merck, and one of the researchers.
They used these three definitions:
• Community-onset-community-associated: CDI occurred in an outpatient setting or within three calendar days after hospital admission and the patient had not had an overnight hospital stay in the prior 12 weeks before onset of infection;
• Community-onset-hospital-associated: CDI occurred in an outpatient setting or within three days after hospital admission, but the patient had spent at least one night in the hospital in the prior 12 weeks to the onset of infection; and
• Hospital-onset: CDI occurred after spending three days in the hospital.
Although not knew information—other studies as well as the Centers for Disease Control and Prevention (CDC) have reported community-acquired infection—they were surprised by how many cases were community acquired.
From 2008 to 2015, the total number of CDI cases increased from 14,686 to 25,273 (72% increase, P<0.01).
Those that were Community-onset-community-associated rose from 6,586 to 13,975 (112%, P<0.01).
While the cases that probably stemmed from a hospital exposure also increased, the rate was much lower, according to Dr. DeRyke.
Those that were community-onset-hospital-associated rose from from 4,545 to 6,524 (44%, P<0.01); while hospital-onset rose from from 3,555 to 4,775 (34%, P<0.01).
The community-onset-community-associated cases accounted for half of overall cases and proportionately increased from 45% in 2008 to 55% in 2015 (P<0.01).
They also looked at cases geographically and found that the Midwest had the highest CDI rate in the country.
“The rates of C. diff are increasing over time,” he said. “Despite all these efforts to eliminate C. diff, it continues to increase.”
Ambulatory patients and caregivers will find the same problems that hospitals have in trying to rid the environment of C. difficile, he said. “The problem is, it’s everywhere,” he said and recommended that any person caring for a patient with CDI make sure that they wash their hands frequently and disinfect with bleach.
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